Main Article Content
Objective: Flow cytometry (FC) is a diagnostic method supporting traditional morphological examination in disease follow-up and the diagnosis of Multiple myeloma (MM). Normal and atypical plasma cells (PCs) can be told apart from each other by means of FC method. The plasma cell rate is the highest in the blood obtained in the first aspirate during bone marrow aspiration in MM.
Material and methods: A total of 60 patients that have been diagnosed with MM between 2018 and 2020, including 30 patients whom flow cytometry was studied with the first aspirate during bone marrow aspiration, and 30 patients whom FC was studied with the second aspirate were included in our study. The characteristics of the patients were analyzed retrospectively from their files.
Results: The median ratio of plasma cells (PCs) detected by FC and bone marrow biopsy was 17,5% and 44%, respectively. While this rate was median 37,5% in patients that flow cytometric study was performed with the first aspirate, the rate was found to be median 7% in patients that FC was performed with the second sample. The PCs rates were statistically significantly higher with the flow cytometric study with the first aspirate than the second one (p=0.000).
Conclusion: Flow cytometric study with the first aspirate during bone marrow aspiration in patients with MM is diagnostically important.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
2. Gerecke C, Fuhrmann S, Strifler S, Hieber MS, Einsele H, Knop S. The Diagnosis and Treatment of Multiple Myeloma. Dtsch Arztebl Int 2016; 113: 470–6
3. Rajkumar SV, Dimopoulos MA, Palumbo A, et al.: International myeloma working group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014; 15: 538–48.
4. Rawstron A.C., Orfao A., Beksac M., et al. Report of the European Myeloma Network on multiparametric flow cytometry in multiple myeloma and related disorders. Haematologica 2008; 93, 431–8.
5. Bataille R, Robillard N, Avet-Loiseau H, Harousseau JL, Moreau P. CD221 (IGF-1R) is aberrantly expressed in multiple myeloma, in relation to disease severity. Haematologica 2005;90:706–707.
6. Terstappen LW, Johnsen S, Segers-Nolten IM, Loken MR. Identification and characterization of plasma cells in normal human bone marrow by high-resolution flow cytometry. Blood 1990;76:1739–1747.
7. Sezer O, Heider U, Zavrski I, Possinger K. Differentiation of monoclonal gammopathy of undetermined significance and multiple myeloma using flow cytometric characteristics of plasma cells. Haematologica 2001;86:837–843.
8. Hundemer M, Klein U, Hose D, Raab MS, Cremer FW, Jauch A, Benner A, Heiss C, Moos M, Ho AD, et al. Lack of CD56 expression on myeloma cells is not a marker for poor prognosis in patients treated by high-dose chemotherapy and is associated with translocation t(11;14). Bone Marrow Transplant 2007;40:1033–1037.
9. Liu H, Yuan C, Heinerich J, Braylan R, Chang M, Wingard J, Moreb J. Flow cytometric minimal residual disease monitoring in patients with multiple myeloma undergoing autologous stem cell transplantation: A retrospective study. Leuk Lymphoma 2008;49:306–314.
10. Lin P, Owens R, Tricot G, et al. Flow cytometric immunophenotypic analysis of 306 cases of multiple myeloma. American Journal of Clinical Pathology 2004; 121, 482–8.
11. Kobayashi S, Hyo R, Amitani Y, et al. Four-color flow cytometric analysis of myeloma plasma cells. American Journal of Clinical Pathology 2006; 126, 908–15.
12. Mateo G, Montalban M.A, Vidriales M.B, et al. Prognostic value of immunophenotyping in multiple myeloma: a study by the PETHEMA/GEM cooperative study groups on patients uniformly treated with high-dose therapy. Journal of Clinical Oncology 2008; 26, 2737–44.
13. Rawstron A.C, Davies F.E, DasGupta R, et al. Flow cytometric disease monitoring in multiple myeloma: the relationship between normal and neoplastic plasma cells predicts outcome after transplantation. Blood 2002;100, 3095–3100.
14. Cannizzo E, Bellio E, Sohani AR et al. Multiparameter Immunophenotyping by Flow Cytometry in Multiple Myeloma: The Diagnostic Utility of Defining Ranges of Normal Antigenic Expression in Comparison to Histology. Cytometry Part B (Clinical Cytometry) 2010; 78B:231–238
15. Ocqueteau M, Orfao A, Almeida J, et al. Immunophenotypic characterization of plasma cells from monoclonal gammopathy of undetermined significance patients. Implications for the differential diagnosis between MGUS and multiple myeloma. Am J Pathol 1998;152:1655–1665.
16. Terstappen LW, Johnsen S, Segers-Nolten IM, Loken MR. Identification and characterization of plasma cells in normal human bone marrow by high-resolution flow cytometry. Blood 1990;76:1739–1747.
17. Bataille R, Jego G, Robillard N, et al. The phenotype of normal, reactive and malignant plasma cells. Identification of ‘‘many and multiple myelomas’’ and of new targets for myeloma therapy. Haematologica 2006;91:1234–1240.
18. San Miguel J.F, Almeida J, Mateo G, et al. Immunophenotypic evaluation of the plasma cell compartment in multiple myeloma: a tool for comparing efficacy of different treatement strategies and predicting outcome. Blood 2002; 99, 1853–1856.
19. Paiva B, Vidriales M.B, Cervero J, et al. GEM/ PETHEMA Cooperative Study Groups. Multiparameter flow cytometric remission is the most relevant prognostic factor for multiple myeloma patients who undergo autologous stem cell transplantation. Blood 2008;112, 4017–23.
20. Pavia B, Cedena MT, Puig N, et al. Minimal residual disease monitoring and immune profiling in multiple myeloma in elderly patients. Blood. 2016;127(25):3165-3174
21. Nadav L, Katz B.Z, Baron S, et al. Diverse niches within multiple myeloma bone marrow aspirates affect plasma cell enumeration. British Journal of Haematology 2006; 133, 530–532.
22. Terpstra W.E, Lokhorst H.M, Blomjous F, et al. Comparison of plasma cell infiltration in bone marrow biopsies and aspirates in patients with multiple myeloma. British Journal of Haematology 1992; 82, 46–49.
23. Ely S. Using aspirates for multiple myeloma research probably excludes important data. British Journal of Haematology 2006; 134, 238–246